 My topic for paper presentation is evaluation of multi-detector computed tomographic pulmonary angiography findings in suspected cases of pulmonary thromboembolism. I am Dr. Mehag Balani, resident of Radio Diagnosis Pravara Rural Medical College, LONI. I have done the study under the guidance of Dr. Yogendra Sachdev, professor and head of department, Pravara Rural Medical College, LONI. What exactly is pulmonary embolism? It is partial or total occlusion of one or more central or peripheral pulmonary arteries by thrombi that originate typically in the large veins of the lower extremities. It is mostly non-specific clinical presentation. It is often referred to as the great mass friendly and remains a diagnostic challenge to both the clinicians and the radiologists. Diagnostic algorithms are needed to assist clinical assessment and optimize the use of diagnostic tests especially in an emergency setting. The most striking advantage of multi-detector computed tomography technology is its fast data acquisition and 3D reconstruction which allows for a distinct examination protocol. The shorter scan time reduces cardiac and respiratory motion artifacts, making vessels adjacent to the heart easier to visualize and thin collimation improves the depiction of sub-segmental arteries. Its advantage of the high scan speed may be future reduction of the required amount of contrast material needed to achieve a high level of enhancement. High-pitch dual-source CtPA is freely breathing patients effectively avoids artifacts related to breath or breathing as well as to cardiac motion at low radiation exposure. It is beneficial to patients as it is fast and has reduced requirement of intravenous contrast. It is a factor beneficial to the patients with cardiac and renal failure. CtPA is the current gold standard in suspected cases of pulmonary thromboembolism. Combining CtPA with clinical pretest probability of pulmonary embolism yields superior sensitivity and specificity than imaging alone. The modern MD-CtPA is highly sensitive and specific for the diagnosis of pulmonary embolism and a single negative study can safely exclude PE. MD-CtPA has been established as the first imaging test due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of pulmonary embolism for further risk stratification. What are the basic causes of pulmonary embolism? An acute PE that manifests as complete arterial occlusion, the affected artery may be enlarged. In acute PE, partial filling defect forms acute angles with respect to the vessel wall when seen on angiography or MD-Ct. Other findings are evidence of recanalization, webs or flaps and partial filling defects that form obtuse angles with the vessel wall. The intimal irregularities are broad-based and smooth with margin abnormalities that create obtuse angles with the vessel walls. Intimal regularities, irregularities can be unilateral or bilateral. Intimal irregularities can also be due to plaques, secondary to pulmonary hypertension. CTPA has also found to be cost-effective and widely available. Some of the limitations, though, include the use of ionizing radiation with a relatively high radiation dose, also contradicted in patients with allergy to iodinated contrast media. It causes reduced renal function. So what are the aims and objectives of this paper presentation? My aim was to assess the evaluation of multi-detector computed tomographic pulmonary angiography findings in suspected cases of pulmonary thromboembolism in patients referred to the Department of Radiodiagnosis at Prevra Rural Hospital, Loni. The objectives were to study the radiological findings on MD-CtPA in clinical suspected cases of pulmonary thromboembolism and to study the common clinical presentation of patients with suspected pulmonary thromboembolism to study the proportion, age and gender distribution. This is a descriptive study design. It was carried out on 93 patients referred by clinicians with a clinical suspicion of pulmonary embolism. The study sample was minimum 93 cases. As per the open API method, my study period was 2 years from September 2020 to September 2022 and the study area was Department of Radiodiagnosis, Rural Medical College, Loni. The inclusion criteria that I used was patients and guardians who were ready to give return informed consent, patients with suspected PE referred by clinicians to Department of Radiodiagnosis with requisition form for MD-CtPA within the study period, no history of allergy to ironated contrast media and the exclusion criteria that I used was the non-consenting patients were not taken. My study was performed on Siemens multi-slide somatome perspective, 64 rows, 128-slice machine. The technique for intravenous assess introduction of an 18-gauze catheter into the anti-cubital vein was done. The patient was positioned supine within the CT gantry with both arms extended and resting comfortably below the head. All CT examinations were performed on a 128-slice machine. Images of the thorax were acquired in a cranial cordial direction using the following parameters. A collimation of 64 by 0.6 mm with a pitch of 1.3 and rotation time of 0.6 seconds was used. Acquisition time was roughly 4.51 seconds. The diagnostic criteria of acute and chronic PE is described with complete arterial occlusion with failure to opacify the vessel lumen, that is giving the vessel cut off sign. Arterial may be enlarged as compared to others of the same order. Central filling defect surrounded by contrast and peripheral intra-luminal filling defect that makes an acute angle with the arterial wall is seen. To diagnose a case of chronic pulmonary embolism complete occlusion of vessel that is smaller as compared to others of the same order and peripheral intra-luminal filling defect that makes obtuse angles with the arterial wall. The statistical analysis was done. The data was coded and entered into Microsoft Excel spreadsheet. Analysis was done using SPSS version 16 Windows software program. Categorical variable were presented as frequency and percentage distribution. Continuous variables were presented as mean and standard deviation. The data was checked for normality before statistical analysis used. My results were I have categorized the results into 10 tables, a table 1, giving us the MDCTPA findings of PE in clinically suspected pulmonary embolism patients. Out of the patients that were suspected to have pulmonary tomber embolism around 33 were out of 93. 33 out of 93 were having pulmonary embolism that was about 35% age. That was about 35% age. Age distribution of clinically suspected pulmonary embolism patients in relation to the MDCTPA findings. The majority that we can see here is in the age group more than 60. That gives us these were the suspected patients and total present were also more in the age group of more than 60. Gender distribution of clinically suspected pulmonary embolism patients. The patients presented with different complaints such as dyspnea, chest pain, cuff, and hemoptysis. We have calculated the clinical history of clinically suspected pulmonary embolism patients. The investigation that they have already undergone was chest radiograph all patients who were suspected to have pulmonary embolism had undergone a chest radiograph. Over 41.9% had done the de dimer values, USG was done in about 28% patients and other tests were done in 59.1% patients. The findings that we could find were these are the categories that we used pulmonary embolism, no pulmonary embolism, pleural effusion that is either right sided or bilateral and additional diagnosis if any, like consolidation in pharx and adelectasis. The risk factors in clinically suspected cases were also tabularized. The major risk factors were DVT and also now commonly we could see increased risk in patients who had had a history of COVID-19 pneumonia. Recent trauma before immobilization or long standing immobilization due to trauma. Other fewer with reduced percentages were malignancy, OC pills, surgery or others. These are the bar diagrams depicting the same anatomical distribution of the location of pulmonary embolism was categorized into a tabular and bar diagram form with majority seen in segmental arteries that we could see and subsegmental with a percentage of 90.9 and 87.9 respectively. The ratio of main pulmonary artery to ascending yota diameter was also calculated and tabularized. Ratio of right ventricle to left ventricle diameter was also tabularized. This is my case number one in the axial pulmonary embolism specific window showing left superior segmental artery thrombus and minimal pleural effusion. We could also see a wedge shaped area of consolidation in superior segment of left lower lobe representing infacted lung. This is my case number two. The patient presented with sudden onset dyspnea and chest pain. The patient is a known case of hypertension. The age is only 23 but we could see a non-enhancing thrombus in bilateral upper lower arteries and its branches in right we could also see it in right main pulmonary in right main pulmonary artery and in left descending interlober artery. We we also saw a enlarged pulmonary trunk with maximum diameter of 29.1 mm near its bifurcation as compared to the adjacent ascending yota with a diameter of 23.17 mm. Case number three. The patient presented with sudden onset of dyspnea with a past history of venous thromboembolism. The D-rhymer was positive for this patient at the the patient presented at the age of 53. The MDCTPA was done and we could see a non-enhancing thrombus in main pulmonary artery extending into left pulmonary artery. According to the discussion of this paper a total of 93 patients with clinically suspected pulmonary embolism were evaluated for MDCTPA for confirmation of pulmonary embolism within the study period after having met the inclusion criteria. Our study showed that the age range in suspected PEs is wide with a mean range of 50.9 years and a median age of 51 years. The majority of patients in both groups that is patients with suspected PE and also found to have PE were aged 60 years and above which is in agreement with many other studies which showed that the prevalence of PE increases with age. Males represented 46 of all participants while females were 47. The male to female ratio with suspected PE was 1 is to 1.02. Our study results were in conclusion with Robert Abbattie et al. study which concluded that in spite of some differences in the clinical presentation of pulmonary embolism between women and men clinical probability prediction scores perform equally in both genders. A high prevalence of PE associated DVT in men could possibly indicate greater severity of PE episodes and partly account for the higher thromboembolism rate in men. In our study the commonest clinical presentation of suspected PE patients which were referred for MDCTPA was found to be disnear which was present in all 93 patients followed by chest pain followed by chest pain, cuff and hemoctasis. However, there was no significant association between the clinical history and PE. This is in keeping with reported literature that are shown PE presents with non-specific symptoms. Out of the 93 suspected patients 33 patients have an evidence of pulmonary embolism while 60 patients did not have an evidence of pulmonary embolism. 19 out of 33 patients with PE had an additional diagnosis while 26 out of 60 patients without PE had an alternative diagnosis. These results were again compared to another study. Our study results with maximum incidence of PE in segmental arteries were in correlation with the study of U.S. et al which reported that there was proximal extension of embolism maximum into the segmental arteries followed by central, low bar and subsegmental arteries. Plural effusion was the commonest in other findings. We found that a clinical history of DVT and COVID-19 pneumonia was reported in a group of 21 patients with clinical suspicion of pulmonary embolism out of whom 14 that 66% had PE. Patients with DVT and COVID-19 pneumonia were 5.58 times more likely to have PE on MDCT-PA. Also, patients with a history of previous venous thromboembolism along with DVT were 5.18 times more likely to have PE. We had similar risk factor findings as mentioned in a study earlier conducted. According to the conclusion of the study, MDCT-PA reveals significant adhesional diagnosis which ensures appropriate patient management and is instituted without delay. Not all dyspnea is due to pulmonary thromboembolism. Parankymal abnormalities in pleural effusion are present in majority of patients undergoing MDCT-PA for the clinical suspicion of pulmonary embolism irrespective of the presence or absence of pulmonary embolism. Other than wedge-shaped abasities, parankymal and pleural abnormalities on MDCT-PA do not correlate with the presence of PE in the study. Evidence of right ventricular strain on MDCT-PA as evidenced by right ventricular to left ventricular diameter ratio more than 1 is significantly associated with pulmonary embolism and predicts risk for adverse outcomes. MDCT-PA reduces mortality and improves cost-effectiveness in the diagnostic work of patients. These are my references. Thank you.